Ismi sharifi _____________________________________
Otasining ismi___________________________________
Millati ________________________________________
Tug‘ilgan yili___________________________________
Ish joyi________________________________________
Kasbi__________________________________________
Ko ‘rsatkichlar
Ishchi Maktab o‘quvchisi
Xizmatchi Oliy
Boshqalar O‘rta
O‘rta maxsus
Ma’lumoti bo‘yicha
1-4 – sinf 5-6 sinf 7-8-9 – sinf
O’rta maxsus, tugallanmagan oliy, Oliy
Qayerda o’qiydi _________________________________
Uyining manzili _________________________________
Telefon raqami__________________________________
Ish joyi ________________________________________
Mazkur kutubxonaga 20___ yildan beri a’zo
Kutubxona qoidalarini bilaman va bajarishga va’da beraman. ______________________________________
Imzo: _________________________________________ To’ldirilgan yoki qayta to’ldirilgan sana ______________
Kitobni qaytarish muddati
Jihoz №
Bo’lim
Kitob muallifi va nomi
Kitobxonning kitobni olganligi haqida imzosi
Kutubxonachi belgilari _________________________________
______________________________________________________________________________________________________________________________________________________________________________________________________
Yana qanday kutubxonalardan foydalanganligi _
____________________________________________________________________________________________________________________________________
Jamoatchilik topshirig‘i ________________________________